Prevalence And Associated Factors Of HIV Infection Among MSM In Hefei: A Cross-Sectional Study

Background In 1981, the first cases of AIDS(Acquired Immune Deficiency Syndrome) were identified among gay men in the United States, and China’s first AIDS case was reported in a traveller from abroad who subsequently died in Beijing in 19855. UNAIDS pointed out that men who have sex with men(MSM) became the prominent contributing factor to new HIV infection in the Asia-Pacific region. Prevalence of HIV among MSM ranged from 7.5% to 30.8% in India,Thailand, Cambodia and Indonesia. In China, a total number of 48 000 people were newly diagnosed with HIV infections in 2011, and 29.4% were infected via homosexual transmission. From 2009 to 2011, several meta-analysis of HIV among Chinese MSM reported pooled HIV prevalence as 2.5%- 15.8%. Anhui, lags behind other municipalities both economically and in terms of social development, and has many of the floating population. It is close to Nanjing and Shanghai with high prevalence of HIV among MSM. The last century has witnessed a number of AIDS villages because of illegal blood selling in rural Anhui Province. Growing studies suggest that not only individual factors but also social factors and structural factors influence the risk of HIV acquisition, disease progression, distribution of HIV/AIDS in population subgroups and HIV transmission dynamics. Our understanding of multi-level factors have been reported in other places, whereas studies on such questions among MSM in Hefei are lacking. To fill the gap, we assess the factors associated with HIV infection among MSM in Hefei with the aim of providing credible estimates of HIV prevalence and related risk factors in this city.Objectives(1) To understand the prevalence and epidemiologic characteristics of HIV/AIDS among MSM in Hefei;(2) To identify the factors associated with HIV infection by univariate and multivariate logistic regression analysis;(3) To explore the measures and strategies for HIV prevention among MSM in Hefei.Methods From August 2013 to May 2014, MSM were recruited for a cross-sectional HIV and behavioral survey in Hefei, Anhui, China. Participants met with the trained researcher at various venues including Disease Control and Prevention(CDC) of Luyang District, Hefei CDC, MSM bars and MSM saunas. Participants were recruited through snowball sampling.Inclusion criteria of the study were MSM, having male-to-male sexual risk behaviors in the past and physically able and willing to participate in the study. The content of structured questionnaire included demographical characteristics, knowledge of HIV/AIDS, homosexual behaviors, heterosexual behaviors, drug use, history of sexually transmitted infections(STIs), having received HIV testing. Questionnaire data was analyzed with Epi Data version 3.0(Epi Data Association, Odense, Denmark) and SPSS(PAWS statistics 18.0). Risk factors that were significant at P<0.1 in univariate logistic regression analysis were entered into the stepwise logistic analysis model. Multivariate logistic regression analysis was used for the significant variables in the bivariate analysis and it was applied to calculate odds ratios(ORs) for risk factors related to HIV results. Significance was set at P< 0.05, and ORs were reported with 95% confidence intervals(CIs).Results(1) A total of 587 MSM were recruited in this study. On average, MSM were aged 28.13±6.91. 415(70.70%) were under the age of 30. 74.45% of MSM were single at present. 515(87.73%) of the participants were local residents and 12.27% lived indifferent provinces.(2) The awareness proportion was 95.40%(560/587) in the cross-sectional study. By univariate analysis, the awareness of HIV/AIDS was not associated with HIV infection(OR=1.64, 95% CI: 0.06-4.49, P=0.331).(3) While 91.99% of participants reported that they had the experience of having anal sex with a man, only 153(28.33%) always used condoms during anal sex with a man in the previous 6 months. 1.67% accepted commercial anal sex with a man in the last 6 months. 110(18.74%) of MSM had sex with female in the past 6 months. The number of MSM who reported drug use throughout their lifetime was 7.(4) The proportion of STIs symptoms among MSM was reported as 2.73%, and 49.40 % of respondents received HIV testing in the past year. Of all the respondents, 73(12.44 %) were infected with HIV and 56(9.54%) were infected with syphilis.(5) Factors that were significant at P<0.1 in univariate logistic regression analysis were entered into the multivariate logistic analysis model. The factors included “age”, “current marital/relationship status with female”, “educational level”, “had sex with female in the past 6 months”, “self-reported STIs”, “received HIV testing in the past year” and “syphilis status”. Results of multivariate analysis showed that MSM who had STIs( P<0.001) and syphilis infection(P<0.001) were more likely to be HIV positive. Respondents who received HIV testing in the past year were at lower risk of HIV infection(P<0.001).Conclusions The survey indicates that the estimated prevalence of HIV among MSM in Hefei is higher than the average level of China. Self-reported STIs and syphilis infection are the risk factors, but HIV testing is associated with a lower risk of HIV infection. We appeal to increase efforts to make HIV/syphilis testing opportunities more accessible so that gays can learn their HIV infection status and accept appropriate care and prevention services. Suggested strategies include screening and treatment for other STIs,free condoms, supporting from HIV/AIDS outreach volunteers, voluntary counseling and testing(VCT) services and prevention programs of HIV/AIDS related knowledge for MSM.